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Forcible Medication Order Reversed

Deborah Elkins//July 28, 2015

Forcible Medication Order Reversed

Deborah Elkins//July 28, 2015

A divided 4th Circuit panel reverses an order allowing forcible medication of a detainee who suffers from a delusional disorder to render him competent to stand trial on a charge of firing a handgun at a Coast Guard helicopter; the court says the government did not meet its burden to justify forcible medication.

Following his arrest for firing a handgun at a Coast Guard helicopter, appellant John Watson, Jr., who suffers from Delusional Disorder, Persecutory Type, was found incompetent to stand trial and committed to the custody of the Attorney General for mental health treatment and evaluation. The court granted the government’s request that Watson be medicated by force. Given the critical liberty interests at stake, we require the government to meet a heavy burden to justify forcible medication, and we require courts to conduct a searching inquiry in order to ensure that this burden is met. In this case, we conclude, the government has not met its burden of proving that involuntary medication is substantially likely to restore Watson’s competency, as required by Sell v. U.S., 539 U.S. 166 (2003), and we reverse.

In this context, we require that the government prove by clear and convincing evidence each of four factors. First, the government must show that important governmental interests are at stake and that special circumstances do not sufficiently mitigate those interests. Second, the government must show that involuntary medication significantly furthers its interests, which requires proof that the medication is substantially likely to render the defendant competent to stand trial and substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist counsel at trial.

Third, the involuntary medication must be necessary to further the government’s interests, and less intrusive means must be unlikely to achieve substantially the same results. Finally, the court must conclude that the administration of drugs is medically appropriate and in the patient’s best medical interests in light of his medical condition. With this demanding standard in mind, we now consider whether the district court properly found that forcible medication is justified in this case.

In sum, the district court in this case did not undertake the searching and individualized assessment of Watson’s likely susceptibility to forcible medication that is required by our case law. It took the government at its word when it argued that the requirements of Sell had been met, without considering whether the government had produced evidence relating the proposed treatment plan to the individual defendant’s particular medical condition. This failure to apply the proper legal standard exacerbated the district court’s apparent failure to consider the concerns raised by a report that related to Watson specifically. The district court overlooked the issue lying at the heart of this case: the meagerness of the evidence that forcible treatment is substantially likely to restore Watson’s competency, when his particular medical situation is taken into account — especially as evaluated under the requisite clear and convincing standard of proof. We hold that the district court clearly erred in finding that the government has met its burden of proving by clear and convincing evidence that the proposed treatment plan, as applied to this particular defendant, is substantially likely to render the defendant competent to stand trial.

We further conclude that this is the rare case in which a remand is inappropriate because the record permits only one resolution of the factual issue: that this burden cannot be met.


Traxler, J.:  Appellant does not challenge the sufficiency of the government’s evidence establishing the necessity of medication. Instead, he argues that the district court erred by not requiring supportive therapy in addition to medication, which appellant contends would increase the likelihood that he would be restored to competency. This court generally does not address issues not raised by the parties, and I believe it inappropriate in this case for the majority to reverse the district court on an issue raised sua sponte. If the issue were properly before us, however, I would find the evidence in the record sufficient to support the district court’s order.

Because I believe that the only error in this case is the district court’s failure to address the issue of adjunctive supportive therapy, I would vacate the district court’s order. I believe the proper course in this circumstance is to vacate and remand for additional findings, not simply reverse the district court outright. I respectfully dissent.

U.S. v. Watson (Harris) No. 14-4388, July 17, 2015; USDC at Alexandria, Va. (Ellis) Nicholas J. Xenaxis, FPD, for appellant; Julia K. Martinez, AUSA, for appellee. VLW 015-2-131, 79 pp.

VLW 015-2-131

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